1912329202 NPI number — ALLCARE FOOT AND ANKLE CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912329202 NPI number — ALLCARE FOOT AND ANKLE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLCARE FOOT AND ANKLE CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912329202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370515
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89137-0515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-522-7731
Provider Business Mailing Address Fax Number:
702-522-7832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7350 W CHEYENNE AVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89129-7445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-522-7731
Provider Business Practice Location Address Fax Number:
702-522-7832
Provider Enumeration Date:
01/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HONG
Authorized Official First Name:
EUNAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
710-522-7731

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  1207 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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